344 C. P. HOWARD 



Paratljyroid Disorders. The observations of Vincent and Jolly reveal 

 the morphological and functional relationships between the parathyroid 

 and thyroid glands and that "when the thyroid is removed the parathy- 

 roids appear capable of functionally replacing it to a certain extent and 

 their histological structure changes accordingly." 4 However true this 

 may be of the experimental normal glands, Humphry examined the para- 

 thyroid glands from four cases of Graves' disease and noted no signs 

 of compensatory hypertrophy or any evidence of the gland cells' becom- 

 ing more specialized and forming colloid. He found, on the other hand, 

 an extensive fat infiltration in three of the four cases; further, micro- 

 scopically in one case at least, the cell protoplasm was diminished while 

 the cell nuclei were large and crowded together. Humphry admits that 

 some degree of fatty infiltration of the gland may occur normally. The 

 investigations of W. G. MacCallum have proven that the part played by 

 the parathyroid glands is neither important nor specific. While we 

 have seen only one case of tetany complicating Graves' disease there are 

 numerous references to such in the literature (Steinlechner's for ex- 

 ample) and tetany of course was formerly not uncommon following 

 strumectomy when some injury has been inflicted on the parathyroid 

 glands or their blood supply. 



Gonads, Disorders in Function of. Cheaclle long ago called atten- 

 tion to the atrophic changes of the genitalia in exophthalmic goiter. No 

 appreciable anatomical change has been noted in the male sex glands, 

 though, as previously stated, loss of libido and potentia is not uncommon. 



According to Elmer "the behavior of the thyroid during puberty, 

 menstruation, pregnancy, labor and lactation argues in favor of its close 

 relation to the uterus and its dependencies." He quotes Freund's state- 

 ment that without exception there was a chronic atrophic parametritis 

 in all his cases of exophthalmic goiter. Dysmenorrhea and amenorrhea 

 are quite common, but scarcely more frequent than in other systemic dis- 

 eases. Repeated pregnancies are by no means rare during the course 

 of the disease. Atrophy of the uterus has been very occasionally re- 

 ported. Elmer believes that there is an unusual frequency of uterine 

 neoplasms with thyroid abnormalities, more particularly with various 

 forms of typical and atypical exophthalmic goiter. He has not been able 

 to confirm the teaching of some that surgical removal of one will benefit 

 the progress of growth in the other. 



The loss of the pubic and axillary hair has been assigned by some 

 to atrophy of the sexual apparatus. The breasts usually atrophy with 

 the iieneral emaciation but occasionally the atrophy is unilateral; here 

 again, alterations in the sexual activity may play a role. In Basedow's 

 male ease there was unilateral distention of the veins. 



4 Vincent lias recently expressed a doubt of the validity of his former views on 

 this subject. R. G. H. 



